Provider Demographics
NPI:1992246524
Name:FISHBEIN, JOSEPH DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:FISHBEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:DANIEL
Other - Last Name:FISHBEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6915 DIANA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1562
Mailing Address - Country:US
Mailing Address - Phone:443-928-9156
Mailing Address - Fax:
Practice Address - Street 1:4900 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8985
Practice Address - Country:US
Practice Address - Phone:850-477-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty